The Clot Thickens: COVID-19-Related ST-Elevation Myocardial Infarction in the Setting of Recent Boosters

Abstract

The coronavirus disease of 2019 (COVID-19) has an array of pathological effects that continue to be discovered. Vaccines against COVID-19 have quickly emerged as our main tool. However, the thrombotic risk of both the virus and the vaccine is yet to be established, let alone together. In this case report, we present a case involving a recently diagnosed COVID-19 patient who developed an ST-elevated myocardial infarction (STEMI) after receiving his booster shot. Our aim is to highlight the standard of treatment outcomes in COVID-19-associated clots, familiarize ourselves with the complexity of the clot burden in a COVID-19-associated STEMI, and illustrate the potential role of the cumulative pro-thrombotic effects of a recent COVID-19 booster with a concomitant symptomatic COVID-19 infection.

Keywords: coronavirus disease-2019 (covid-19); covid 19 induced thrombosis; covid-19 vaccine complication; pci (percutaneous coronary intervention); st elevated myocardial infarction (stemi).

Figure 1. Admission electrocardiogram

The admission electrocardiogram demonstrated ST elevation in inferior leads II, III, and aVF suggestive of acute inferior infarct secondary to right coronary involvement. The EKG also demonstrated sinus tachycardia.

Figure 2. Ultrasound lower extremity venous doppler bilateral

(A) Left mid femoral vein demonstrating partial flow, (B) left femoral vein distal, and (C) left popliteal vein. After the percutaneous coronary intervention procedure, the patient had complaints of left leg pain. An ultrasound of bilateral lower extremities revealed an acute left lower extremity deep venous thrombosis extending from mid femoral to the popliteal vein. Note the mid femoral vein demonstrated partial flow only.